Classification of Diabetic Retinopathy by Deep Learning

Diabetic retinopathy (DR), which is a leading cause of adult blindness, primarily affects individuals with diabetes. The manual diagnosis of DR, with the assistance of an ophthalmologist, has proven to be a time-consuming and challenging process. Late detection of DR is a significant factor contributing to the progression of the disease. To address this issue, the present study utilizes deep learning (DL) and transfer learning algorithms to analyze different stages of DR and precisely detect the condition. Using a large dataset comprising approximately 60,000 images, this study employs ResNet-101, DenseNet121, InceptionResNetV2, and EfficientNetB0 DL models to automatically assess the progression of DR. Images of patients’ eyes are inputted into the models, and the DL architectures are adapted to extract relevant features from the eye images. The study’s findings demonstrate that DenseNet121 outperforms ResNet-101, InceptionResNetV2, and EfficientNetB0 in accurately classifying the five stages of DR. The accuracy of the models was 97%, 96%, 95%, and 94%, respectively. These results underscore the effectiveness of DL in achieving an accurate and comprehensive classification of retinitis pigmentosa. By enabling accurate and timely diagnosis of DR, the application of DL techniques significantly contributes to the field of ophthalmology, facilitating improved treatment decisions for patients

Burden of non-communicable diseases in Tunisia, 1990-2017: results from the global burden of disease study

Introduction: non-communicable diseases (NCDs) are the leading cause of mortality and disability worldwide especially in developing countries such as Tunisia. We aimed to describe the national burden of non-communicable diseases in 2017 and to analyze disability-adjusted life year trends from 1990 to 2017 in Tunisia by cause and gender. Methods: we used Joinpoint regression analysis to assess trends of the age standardized disability-adjusted life year rate from 1990 to 2017 and to determine average annual percentage change. Results: non-communicable diseases accounted for 87.7% of total disability-adjusted life year in Tunisia in 2017. The five leading causes of this rate in Tunisia in 2017 were cardiovascular diseases, musculoskeletal disorders, neoplasms, mental disorders and neurological disorders. The trend of disability-adjusted life year rate of non-communicable diseases decreased significantly from 23403.2 per 100.000 (95% CI: 20830.2-26285.8) in 1990 to 18454.6 (95% CI: 15611.3-21555.4) in 2017, with a change of -0.9%; p=0.00. The decrease of the age standardized disability-adjusted life year rate concerned mainly cardiovascular diseases and neoplasms secondly. This decrease was more important in female (change=-1.1, p=0.00) in comparison to males (change=-0.7, p=0.00). On the other hand, the increase of the standardized disability-adjusted life year rate was related to musculoskeletal disorders, diabetes, kidney disorders and substance use disorders with a significant annual percentage change of 0.1%, 0.2% and 1.3% (p=0.00) respectively. Conclusion: the implementation of the national strategy is the key solution to mitigate the impact of non-communicable diseases in Tunisia

Patients’ experiences and satisfaction with health care in the Salah Azaiez Institute of Cancer in Tunisia in 2020

Measurement of patient-centered care is a key step to ensure quality of care improvement. The aims of this study were to evaluate the experience of hospitalized patients of Salah Azaiez Institute (SAI) of Cancer of Tunisia in 2020 and to analyze factors associated to the global satisfaction. It was a cross-sectional study. The used questionnaire was derived from the Picker patient questionnaire. Factors associated to the global satisfaction were assessed using Chi-squared and Fisher’s exact tests. The present study concerned 200 inpatients of the SAI. The Cronbach’s α of the patient experience test (PPE-15) was of 0.82 indicating a good internal consistency. According to results of this study, only 38.5% of the patients were satisfied with their hospitalization. Perception of the quality of the received treatment was good to excellent for 57.0%. Regarding the global organization, 56.5% of the patients found it intermediate and 21.5% perceived it as bad. The highest scores among patient experience dimensions concerned the coordination of healthcare, the respect for patient preference and the physical comfort. However, lowest scores were attributed to the involvement of family and friends, the information and patient education and the emotional support. Unlike socio-demographic factors, patient experience and its dimensions was strongly associated to the global satisfaction. Further studies are recommended to explore patient experience dimensions and other determinants of patient satisfaction in Tunisia. Experience Framework This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Antibiotherapy management in respiratory infections in ambulatory in Tunisia

Acute respiratory tract infections are the commonest acute conditions managed in general practice and the main causes of antibiotic use. In Tunisia, the rates of antibiotic prescriptions remain high in general practice. In order to assess antibiotics prescribing practices of 23 general practitioners when facing an ENT or a respiratory tract infection, we conducted an observational study from February 1st, 2014 to November 25th, 2014. The study involved 374 patients, 45.6 mean age of years, among them 193 men (51.6%) and 174 (51.9%) with comorbidities. Tonsillitis, acute maxillary sinusitis and acute bronchitis are the main diagnosis, accounting for over 90% of ENT and respiratory tract infection. The diagnosis of these infections was based on clinical criteria, additional tests were prescribed for only 75 patients (20%). An antibiotic was prescribed for 360 patients (96.2%). β-lactams were the main prescribed class of antibiotics (58.3%). The antibiotic treatment was considered as inappropriate in 42.5% of prescriptions. The main causes were the prescription of amoxicillin-clavulanic acid during tonsillitis, non-antipneumococcal fluoroquinolones, when streptococci or streptococcus pneumoniae are presumed to be responsible for infection (tonsillitis, acute maxillary sinusitis, pneumonia), and unnecessary combination of antibiotics. A concomitant treatment was prescribed for 365 patients (97.6%). The most prescribed drugs were antipyretics (71.4%), corticosteroids (44.7%) and mucolytic (30.2%). The outcome was favorable in 333 cases (89%) and unfavorable in 26 cases (7.1%). The total average cost of an infectious episode was 79.776 ± 36.988 TND (45 ± 20 USD)., with a minimum and maximum values respectively 19.5 and 315.5 TND (35 to 558 USD). This study highlights the frequency of antibiotics prescription (96.2%) during supposed viral infections such as acute bronchitis, tonsillitis or when antibiotic prescription has to be debatable such as in acute otitis media, sinusitis maxillary or exacerbations of COPD. The over-use of antibiotics is an important concern in many countries of the region leading to emergence of bacterial resistance. National guidelines should be developed in order to promote rational use of antibiotics

Predictive factors of morbidity after surgical treatment of hepatic hydatid cyst

Introduction Surgery remains the basic treatment of hepatic hydatid cyst (HHC). However, it is associated with significant morbidity. The aim of our study was to evaluate mortality and morbidity of surgery of the HHC and to highlight the risk factors. Methods A retrospective study was conducted from January 1, 1996 to December 31, 2006. 391 patients hospitalized for HHC and operated in the Department of General Surgery “A” of the Rabta Hospital in Tunis, Tunisia. Results The overall mortality rate was 0.7% while the overall morbidity rate was 20.4%. About 16.6% suffered from specific complications, while 3.8% suffered from non-specific complications. Predictors of morbidity in a univariate analysis included cysts larger than 9 cm, dome cysts, cysts with bilious contents, type II, III, IV or V on ultrasound classification, fissured cysts and intrabiliary rupture of hepatic hydatid cyst. The multivariate study consisted of independent predictors of disease at the site of the liver dome, the cysto-biliary fistula and intrabiliary rupture of hepatic hydatid cyst Conclusion The hepatic hydatid cyst of the dome and the existence of preoperative complications in particular intrabiliary rupture of hepatic hydatid cyst are the main factors of morbidity. A better understanding of these factors allows the surgeon to choose the appropiate surgical technique that is associated with less morbidity.Pan African Medical Journal 2012; 13:2

Premature mortality attributable to smoking among Tunisian men in 2009

INTRODUCTION: Tobacco smoking is a significant public health threat in the world, a risk factor for many diseases, and has been increasing in prevalence in many developing countries. In this study, we aimed to estimate the burden of premature deaths attributable to smoking among Tunisian men aged 35-69 years in 2009. METHODS: The number of deaths attributable to smoking was estimated using the population attributable risk fraction method. Smoking prevalence was obtained from a nationally representative survey. Causes of death were obtained from the registry of the National Public Health Institute. Relative risks were taken from the American Cancer Society Prevention Study (CPS-II). RESULTS: Total estimated premature deaths attributable to smoking among men in Tunisia were 2601 (95% CI: 2268-2877), accounting for 25% (95% CI: 23.3-26.6) of total male adult mortality. Cancer, cardiovascular and respiratory diseases were the major causes of premature deaths attributable to smoking with 1272 (95% CI: 1188-1329), 966 (95% CI: 779-1133) and 364 (300-415) deaths, respectively. CONCLUSIONS: Tobacco smoking is highly relevant and is related to substantial premature mortality in Tunisia, around double that estimated for the region as a whole. This also has not decreased over the past 20 years. Urgent actions are needed to reduce this pandemic

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

SummaryBackground The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding Bill & Melinda Gates Foundation